Longevity is everything, these days. The only point in life is to live as long as possible. Nothing else matters.
Oddly enough, the supremacy of longevity has come at a time when people have been starting to live longer anyway. That’s to say that people haven’t been living longer as a consequence of this new supremacy of longevity in medicine, but rather that the supremacy of longevity is a consequence of a surprising new longevity.
And maybe that’s quite easy to explain. As people live longer, more and more healthcare provisions go into hip replacements and heart surgery and old folks’ homes and nursing homes. An entire industry has grown up that just keeps people alive longer and longer. And in this new industry, longevity is everything. Nothing else matters. And the values of this burgeoning new industry seep into the entire medical profession, the entire public health profession, and from thence permeate all political and cultural life.
And it’s a perfectly viable industry. A lot of these old people are quite wealthy and have good pensions, and they’re prepared to pay handsomely to stay alive. In addition, the state has stepped in to ensure that poorer people get something approximately equivalent too.
Smoking bans are another expression of this new supremacy of longevity. If people don’t smoke, they’ll live a few years longer. Same if they don’t drink. And do some exercise. And keep their weight down. And those few extra years or months are all that matters. And this new imperative is now spilling out of hospitals and care homes, first into the grounds around them, and then into adjacent streets, like a metastasising cancer.
But why are people living longer than they used to do? In the past when I’ve thought about it, I’ve assumed that it was largely because they were better fed and better housed. But thinking some more about it today, I’ve come up with a different explanation.
In my experience, most of the people I’ve known throughout my life – regardless of whether they were fat or thin, smoked, drank, or slept around – were perfectly healthy people most of the time. They only ever wound up in hospitals as a result of accidents like car crashes or sporting injuries. That’s been true of me too. The only time I ended up in a hospital was when I came off a motorbike and slid along a London street, cracking my elbow in the process. The next time I was in hospital, about 30 years later, was when I was offered pioneering keyhole surgery for a mild hernia. I wasn’t sure I really needed it, but accepted the offer, and spent one night in hospital.
For most people, in my experience, pretty much all the health problems start late in life. In her sixties my otherwise healthy mother began to suffer from arthritis which slowly got worse. And around the age of 65, my father started to suffer from what used to be called maturity onset diabetes. But both continued to live active lives.
Their first hospital encounter came when my father fell in the garden and broke his hip, and had a hip replacement op, and took a while getting back on his feet again.
Their next hospital encounter came when my father had a stroke, which left him as vigorously strong as he’d always been, but unable to speak. He spent the next 18 months or so in nursing homes until he died aged 79.
Recently, in the light of revelations about Hillary Clinton, I’ve begun to wonder whether “stroke” wasn’t so much cause as effect. I wasn’t there that day, but my father had driven himself that morning to a hospital to start a course in radiotherapy for incipient bladder cancer, and then driven himself all the way back – a 40 mile round trip. That was probably a pretty exhausting experience. And so when he got home, and my mother called him to the dining room for lunch, this exhaustion (combined with an unsteadiness on his feet I’d previously noticed) may have been the reason why he lost his footing, and fell down, and banged his head against a wall or bookcase or door, and started the internal bleeding that was diagnosed as a stroke. i.e. the stroke quite likely was a consequence of taking a heavy fall, rather than the fall being the consequence of the stroke. Which is what happened with Hillary Clinton some years ago.
In the case of both my father’s falls, ambulances pretty soon arrived at their country home. And that was because my parents had a telephone. It was really modern communication systems – the telephone – that allowed my father to live an extra 14 years.
It was that, and not any advances in medicine, that prolonged his life. For there have been relatively few medical advances. There was no treatment for my mother’s arthritis. And no treatment (apart from dietary changes) for my father’s diabetes. And probably no effective treatment for his incipient bladder cancer. And no treatment for his stroke. The only really effective medical innovation was hip replacement.
And if lots of people have suddenly begun living quite a lot longer, it’s probably because when something happens to them, modern communications now allow them to get help quickly. But that help, when it quickly arrives, is really not much better than it was 100 years ago – because ageing, dementia, stroke, heart disease, arthritis, diabetes, are not really much better understood than they were back then.
I think it’s interesting that in the case of both my parents, falling down and breaking something was actually the main threat to their lives. For about 10 years after my father’s second fall my mother fell and broke her hip as well, and I suspect it caused a slight stroke that left her a bit dotty for the rest of her life. It was also the main threat to the life of an old lady who once acted in loco parentis for me, and who fell out of bed one night, broke a leg, and died two days later.
The first telephones appeared in the UK in about 1880. Public telephone kiosks first seem to have started appearing on UK streets in 1920. The first UK ambulance service started in 1890, most likely because hospitals had begun to be called by telephone, and told about accidents or injuries, and began to see a need for a rapid response. And if the NHS is now overloaded, it’s because over the subsequent century telephones gradually became ubiquitous, and everyone’s got one in their back pocket. Everyone lives longer, and everyone dies of diseases of old age, which hardly anyone used to die of. The epidemic of cancer in the UK, first noted around 1930, was quite likely one of these consequences of the new telephone-assisted longevity.